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cognitive distortions

Gaslighting is a term you probably know, but if you don’t, it refers to the act of telling and convincing someone that their feelings or perceptions are not really true. In the context of interpersonal relationships, gaslighting is considered to be an abusive behavior, as it can render people incapable of trusting themselves and their own judgment, instead placing an undeserved trust in the gaslighter.

Cognitive distortion is also a term you probably know. It refers to a set of maladaptive mental habits that people with mental illnesses tend to have. (The Wikipedia list is useful, and I discussed some specific examples in this post.)

A cognitive-behavioral approach to mood disorders involves teaching the client the difference between thoughts and feelings. A lot of people will say things like, “I feel like a failure.” The therapist’s role is to remind them that “I feel like a failure” isn’t actually a feeling, but a thought. “I feel like a failure” is really “I think that I’m a failure.” The therapist may ask, “How do you feel when you have the thought that you are a failure?” The client may say, “I feel hopeless,” or “I feel miserable.” Hopefully, the therapist can help the client see that a lot of their thoughts are actually cognitive distortions, and that there are more helpful and realistic ways to think about the same things.

That’s the standard CBT frame that’s used in all the training videos I watch in school. But the reality, at least for me, is a little less tidy. Sometimes feelings come seemingly out of nowhere, and while I know there is a reason for them (and I usually know what the reason is), there was no proximal cause for the feeling. There was no maladaptive thought.

Sometimes I see a partner with someone else and I just feel awful. I don’t think, “I bet they’re going to leave me now,” or “That person is way cooler than me,” and then feel awful. I just feel awful. Is it because I trained myself to feel awful on cue, as a conditioned response? Maybe. Others would argue that feeling awful is a “natural” response to seeing a partner with someone else, though I disagree. Regardless, the feeling comes immediately and without any stimulus other than seeing the thing.

Sometimes I have to leave my family after a visit and I become extremely depressed. (I will have to do this in a few days. I’ve already had a few breakdowns about it.) I don’t think, “I WILL NEVER SEE MY FAMILY AGAIN” or, slightly more realistically, “It is Terrible and Bad that I have to leave my family.” I just think about the mere concept of leaving and instantly collapse in tears. (To wit: there is nothing less undignified than collapsing in tears while sitting on the toilet, but that just happened to be when I remembered about my flight home. It happens.)

Last year I wrote about some things I had learned from depression, including two slightly/seemingly contradictory maxims: “Not everything your brain tells you is accurate,” and “Your feelings are valid.” You can read that post to see what I meant by these things, but the jist of it is that depression can teach you to be more skeptical about some of the stuff going on in your brain, but also that you get to feel how you feel without passing judgment–or having others pass judgment–on it. Some would say that feelings can’t be “wrong.” They can be crappy, or not useful, or distracting, or whatever, but they cannot be empirically inaccurate or morally wrong.

However, this is where reality gets murkier than these convenient teachings. Feelings aren’t wrong, per se, but they can be premised on exaggerated or inaccurate fears or worries. I feel bad when my partners like people who I think are Better than me. But what is “better”? Can I really accurately say that someone is “better” than me, rather than maybe better at certain things and worse at others? And isn’t the whole point of polyamory that nobody has to leave anyone just because they’ve found someone “better”?

I feel depressed when I have to leave my family and go home to New York. But I know I will be just fine and quite happy when I get there. I know this because I’ve gone through it many, many times now. There is no reason to feel so depressed I can’t get out of bed for two days. Yes, it’s sad to say goodbye to your family. To me, personally, it is slightly tragic, even, that I can’t live close to them the way people usually do in our culture. But it is not that sad. It is not weeping-on-the-toilet-bowl sad. Few things in my life are objectively that sad.

These are far from the only situations like this that I experience; it happens all the time, every day. I get very frustrated. “No feelings about feelings,” a friend of mine says, not as a rule, but as an aspiration. I can’t make it work.

So I start gaslighting myself. “That’s not true.” “That perception is just wrong.” “That’s false and you know it.” “There is no reason to be upset right now.” “Your hypothesis that that person is somehow objectively better than you is premised on nothing but a pile of turds.” “THAT FEELING IS WRONG AND YOU SHOULD IGNORE IT FOREVER.”

Cutesy slang about jerkbrains and badfeels aside, what I’m now doing is very serious. Now I have abandoned a defensive stance and taken up an offensive one, with which I will battle the Wrong Feelings and vanquish them in a burst of light. Gaslight.

What happens when you teach yourself not to trust your own perception? How many toxic people become “just difficult for me to deal with because I’m so insecure and oversensitive”? How many untenable situations become marginally acceptable because “I’m only miserable about it because my brain lies to me”? How many injustices become annoyances to shrug at because “I’m just pessimistic about everything and don’t realize how good life is”?

People tell me that I’m so good at setting boundaries, but sometimes I wonder how much shit I have patiently accepted because I thought my brain was lying to me. In any case, I’m very glad I discovered feminism at the same time I discovered that I have depression.

Somewhere between “Your feelings are bad and you should feel bad” and “Your feelings are an accurate barometer of external reality” lies a vast unexplored land of feelings that are excessive but useful, of feelings that don’t make any sense but that alert you to an issue that needs to be explored, of feelings that can be discussed with a partner to build trust and intimacy, of feelings that have been spot-on many times before but have simply outlived their usefulness in this new and happier life you have built.

When I think about the frequent charge that therapists and psychiatrists and those who work with them are trying to “medicalize” “normal” emotions like sadness and fear, I think that people don’t really understand how emotions like sadness and fear can be distinguished from mental illnesses like depression and anxiety.

I’ve tried to explain this to many people multiple times, in person and through writing, and so have many other people with mental illnesses as well as professionals in the field. Yet people continue to conflate emotions and illnesses, or rather to assume that mental healthcare advocates are conflating them. It’s often difficult to continue engaging patiently with this claim.

In The End of Normal: Identity in a Biocultural Era, Lennard Davis affirms: “A drug would be a prosthesis if it restored or imitated some primary state that appears to be natural and useful” (64). Davis makes this statement in the context of his argument that SSRIs are not “chemical prostheses” for depression, since happiness is not a “primary state” of being and since there is compelling evidence to suggest that SSRIs do not actually work (Davis 55-60).

I’ll address the SSRIs-not-working thing first since I have less to say about that and it’s not as relevant to this post. The reality seems to be more that SSRIs work well for some people but not at all for many other people and we haven’t really figured out why they work for some people but not others, or more specifically, which types of people they work for and which they don’t. And on a personal note, I’m a little tired of being told that SSRIs “don’t work” when they’re part of the reason I didn’t try to off myself four years ago. There is compelling evidence to suggest they do not actually work and there is compelling evidence to suggest that they do actually work, so I’m comfortable saying that the jury’s still out on this one.

More to the point: antidepressants are not meant to cause “happiness” because depression, the illness they are meant to treat, is not defined by a lack of “happiness.” Depression involves a constellation of physical, emotional, and behavioral symptoms that make happiness very difficult or even impossible. These symptoms have a number of other deleterious effects which vary for different people. There are many ways depression can ultimately “look,” such as being unable to get out of bed, being unable to hold down a job, bursting into tears several times a day over tiny inconveniences or in response to nothing at all, losing your sex drive, being unable to sleep, having to sleep over 12 hours a day, having severe memory loss, losing the ability to enjoy any previously enjoyable activity, experiencing complete emotional numbness, obsessing over death and suicide, physically hurting yourself, or attempting suicide.

Maybe being “happy,” whatever that even means, isn’t a “primary state,” but I would argue that being able to live a relatively normal life in which you can go to school or have a job, have relationships with people, and not want to kill yourself is a “primary state.”

Being treated for (and, hopefully, recovering from) depression does not give you extra things that other people don’t have, such as constant happiness and optimism. It gives you what everyone else has had all along, which is a reasonable and age-appropriate amount of control over your emotional state and the ability to create your own happiness if you want to and make the effort.

By the way, you can definitely be miserable and unhappy without having a diagnosable mental illness, but it’s rare to find a person whose unhappiness is truly caused entirely by their own voluntary actions. Depression can also develop as a result of voluntary actions; for instance, if you have a number of career options available to you but you choose an extremely stressful and mind-numbing (but perhaps lucrative?) option, you might end up becoming depressed because of it. At that point, your best bet might be to find a way to make a career change, but it’s likely that you’ll also need therapy to help undo the maladaptive mental habits that the situation has created. (Medication might help too, but in a case like this I’d personally recommend therapy first.)

I think a better way to explain the difference has been that, at least in my experience of mental illness versus mental health, there are things that mentally healthy people can do to significantly increase their level of happiness, whereas people who are going through a bout of mental illness can rarely make a huge difference just by stopping and smelling the roses or making more time to play with their kids or enrolling in a cooking class or whatever. They can maybe make a small difference, but it’s unlikely to reduce the mental illness symptoms themselves. I used to get so frustrated at things like The Happiness Project and other initiatives of that sort, until I finally realized that they weren’t aimed at me because happiness would literally not even be a possibility for me until I treated my damn mental illness.

(That said, things like that can be very useful for someone whose mental illness is in remission or otherwise low-grade. Right now, I’m not fully symptomatic for depression but I’m aware that it can probably come back at any time, so I do a lot of things to keep my mental health strong to try to avoid it coming back.)

It’s difficult to tease out all the complicated interactions between mental illness, mental health, and happiness, and of course it varies for different people. In my experience–which includes my personal experience, my interactions with friends and partners, and my studies and clinical experience, here it is in a nutshell: untreated/unmanaged mental illness makes happiness virtually impossible to achieve. Treating or managing your mental illness, whether through medication, talk therapy, or personal lifehacking, helps make happiness possible to achieve. But the work of achieving it is still yours to do. No drug or therapist can just give you happiness.

And most people with mental illnesses realize this. I haven’t met anyone who was just like “I wanna go to the psychiatrist and get a pill and just be happy always forever.” Most of us just want to stop crying all the time, or stop having panic attacks whenever we need to interact with new people, or stop having intrusive and scary thoughts of killing ourselves, or stop lying awake for hours each night because we can’t stop imagining all the bad things that could happen to us.

“Happiness” is the cherry on the sundae of mental health. You need to put the ice cream and the syrup and the whipped cream in the cup first.

(I’m not sure what it says about me that in reality I actually despise maraschino cherries and always ask for them to be left off my sundae. This is an analogy that was definitely intended for the presumably more normal people who will read this.)

If you still think that what we call “depression” is just an attempt to medicalize “sadness,” then you don’t know what one or either of those things are. So I’ll illustrate with an example of an internal monologue I have had when I was sad, and one I have had when I was depressed. The subject is the same, but the emotional response isn’t. See if you can figure out which is which!

I really wish I had a partner. It’s lonely not having anyone to come home to and it feels crappy seeing all my friends with their partners even though I know I should be happy for them. Sometimes I wonder if I’m just not that attractive or likable as a person. It seems like I’m the only person not dating anyone. I hope I meet someone soon, but I don’t know when or how that will happen and I’m not that optimistic about it right now.

I really wish I had a partner. I feel like a complete worthless failure because literally everyone else I know is seeing someone and I’m not. I’ll probably never find anyone and I’ll just be lonely for the rest of my life and there won’t be anyone to call 911 if something happens to me and they’ll find my body in my apartment days later because nobody gave enough of a fuck to check on me. Not like I blame them. I’m so ugly and stupid that I don’t know why anyone would even want to hang out with me, let alone go out with me. Everyone’s probably pitying me because I don’t have anyone and everyone can tell that it’s because I’m completely pathetic. I feel like I might as well not even exist because what’s the point of going through life alone and unloved?

One of those is a sensical reaction to lacking something in your life that’s important to you (a romantic relationship); the other is over-the-top. The emotional response in the second example is disproportionate; it doesn’t make sense to leap all the way from “I’m sad because I wish I had a partner” to “I’m a worthless failure and will die alone.”

That second monologue contains a number of characteristic cognitive distortions associated with depression, such as all-or-nothing thinking (I have to have a partner or there’s no point in even living), disqualifying the positive(the good aspects of my life are irrelevant; it’s all bad because I’m single), mind-reading (everyone must be pitying me), fortune telling (because I don’t have a partner now, I will never have one), catastrophizing (something bad will happen to me and I’ll die alone in my home because nobody will help), personalization (it’s completely my fault that I don’t have a partner; none of it comes down to chance or being in the wrong environment or anything else), andemotional reasoning (I feel like a failure because I’m single; therefore I definitely am a failure).

While mentally healthy people do make cognitive distortions too, mental health is a spectrum: the more you’re able to refrain from thinking in these harmful ways, the more mentally healthy you’ll (generally) be. If you look at the first monologue, you’ll see some slight distortions, like the fear that you’re unlikeable or unattractive just because you happen to be single, or the perception that you’re the only person not dating when that’s obviously not true. But only in the second example do these irrational thoughts become all-encompassing. And, importantly, only the second example involves thoughts of death and suicidal ideation.

Note also that in the first example, being single is causing sad feelings, whereas in the second example, the emotional responses are not primarily caused by the singleness. Perhaps being single is the immediate trigger of the extreme sadness and negativity, but what’s really causing it is depression. A depressed person who is miserable about being single will not stop being miserable if they stop being single; they will usually be miserable about other things. That’s exactly what happened to me back when I was having that monologue. I’d inevitably get into a relationship and then be miserable because I didn’t think my partner liked me enough, or because I was worried about school, or because I felt like all my friends hated me, or because I hated myself, or just because.

Depression can trick you into thinking that you’re depressed “about” something. You’re probably not. You’re depressed because you have depression, and luckily, you can treat it.

Sadness, on the other hand, is about things. You can be sad because you’re single or because you got a bad grade or because you hate your job. Sadness is a normal, healthy reaction to experiencing things that you don’t like. It’s a useful and important emotion because it tips us off to situations that we should try to change if we can. Sadness can prompt us to take a step back and think about things and how we would like them to be better.

Medicalizing sadness and medicating it away would probably harm individuals and also our society as a whole. It would make things pretty boring. Isn’t it great that antidepressants and therapy are not actually trying to do that? Isn’t it great that we can help people avoid catastrophic, paralyzing, life-ruining sadness and fear like the ones associated with mental illnesses, while helping them get in touch with healthy and situationally appropriate sadness and fear? That we can help them understand their emotions and use them to change themselves, their lives, or the world, without having their lives completely governed by them?

Indeed. Depression is not sadness. Anxiety is not fear. Nobody is actually trying to eradicate sadness and fear.

I do think that it’s important to address our societal phobia of sadness, grief, and pain. But the way to do that is not to throw the mentally ill under the bus by implying they are running from their negative emotions when they seek out treatment. It also doesn’t mean casting shade on the few tools for treatment of mental illness that we actually have evidence are effective. A diagnosis of depression does not say “this person is too sad”. It says “this person can’t function the way they would like to because their emotions are consistently out of control”. There is a world of difference between those two statements.

This is my series on depression and what it’s actually like beyond the DSM symptoms. It’s not meant to reflect anyone’s experience but my own, although I’m sure plenty of people will identify with it. If things were completely different for you and you feel comfortable sharing, the comments section’s all yours. Previous posts in the series are here.

The title of this post is “Living With Depression: Hope,” but because of the bit before the colon, the part after it is hard to come by.

One of the main ways in which depression differs from sadness or “the blues” is the pervasive loss of hope that its sufferers experience. When you’re depressed, you don’t merely feel bad; you know beyond a doubt that you will always feel bad. You don’t have evidence for this, but the strength of your conviction is so great that you automatically attribute it to accuracy. After all, if it weren’t absolutely true that you will always feel this bad, why else would you be so certain of it?

That’s one of many ways in which the depressed brain tricks you.

Unfortunately, the hopelessness of depression isn’t limited to big-picture questions like whether or not you will eventually feel better. It affects every little thing. You will never make friends. You will never find a partner. You will never have sex again. You will never get a job. You will never get into graduate school. You will never find a place to live that you like. You will never reconcile with your family. You will never get in shape. You will never get these damn errands finished.

(This also means that it’s impossible to tell the difference between what’s actually unattainable and what merely feels that way. I recently told my mother that one of the reasons I chose not to go for a PhD was because there’s absolutely no way I could’ve made it into a doctoral program given my lack of research experience. My mother pointed out that I’d said the same thing about the master’s program to which I will soon be merrily on my way. It’s true. I did say that. I also said that I will never get into Northwestern and never get any summer internships and never find a partner and never find a way to move to New York City. Sometimes I think that I’ll never get married or never be able to get a fulltime job. Which of these are based on a skeptical assessment of the evidence, and which are not? Who knows.)

This is going to sound ridiculous when I say it this way, but imagine knowing for certain that every little bit of your life will always be bad. Imagine if someone traveled back in time from the future and told you that you are going to fail at everything and you will never be happy and nobody will ever like you. Got it? Now try to live out the rest of that life.

That is depression.

When you look at it that way, suicide becomes a little easier to understand. One of the many things healthy people don’t get about suicide is how you could want to end your life for good just because of a “temporary setback” or “when things might get better” or “without knowing how life will turn out.” People call suicide a “permanent solution to a temporary problem.”

Sure, that’s how it looks to a healthy person. But to a depressed person, it’s not a temporary problem. It’s a permanent problem. You do know exactly how life will turn out and it will turn out terribly.

This is why it’s so patently ridiculous to me when people start going on about “Yeah well how can you really know if it’s depression or just sadness I mean aren’t we sort of medicalizing a normal emotion.” This is why it’s so clear that these people have no clue what they’re talking about. I’ve spent a lot of time being depressed and I’ve also spent a lot of time being sad. When I’m sad, my thought process goes like this: “Blah, it’s really fucking sad to be leaving behind my life in Chicago with all these friends I have and all the places I like to go. I will never have these things in my life in this way again. This is really fucking sad. I can’t wait till the move to NYC is over because then I’ll get to acclimate to a new life and it won’t feel as bad to have left this one behind.”

When I’m depressed, my thought process is more like this: “THERE IS ABSOLUTELY NOTHING GOOD ABOUT CHRISTMAS BREAK ENDING AND HAVING TO GO BACK TO CHICAGO. I HATE EVERYTHING THERE. Yeah, I guess I have friends there, but they probably don’t even like me. My classes will probably suck this quarter (yeah I picked them myself but whatever everything I choose for myself always ends up being shitty). The weather fucking sucks and I can’t stand it anymore. I’ll just sit in my apartment alone like a loser. Fuck my life.”

But here’s the thing: when Christmas break ended and I went back to Chicago, it was…fine. I adjusted, as I always do. But in the days leading up to break ending, I was absolutely unable to see that that would happen. It didn’t matter that I’d had the same thoughts at the end of every break. It didn’t matter that I had the same thoughts as I prepared to go home for break, from where I was now so reluctant to leave.

Nothing mattered. I had lost hope. Hopelessness was the default state in which I lived most of the time.

But without hope, there’s no way to be happy or even content. If things are going poorly for you right now, you’re convinced that they will always be that way. If things are going well, you’re convinced that it could all end at any time and your future seems grim.

Without hope, something as mundane as returning to school from Christmas break feels like an insurmountable obstacle. Without hope, my upcoming move to NYC would have me completely paralyzed with dread and anxiety (and I have to say, it’s pretty difficult even with hope).

Without hope, treating your depression feels pointless. Why make the effort when you already “know” it’s not going to help? Without hope, platitudes about “looking on the bright side” are pointless, because depression is an illness that literally prevents you from ever looking on the bright side. Telling a person with depression to try to be hopeful or to try to believe that things will get better is like telling a person with diabetes to consider trying to produce more insulin.

As of a few days ago, my depression has been subclinical for about a year. This means that I don’t fit the diagnostic criteria for it. I do not have major depression. I have recovered.

I do have many of its symptoms, some in mild forms and some a little stronger. So to say that I’m not at all depressed is probably inaccurate. In any case, though, the past year has been an experiment in learning to have hope again–hope that I will adjust just fine to my move in a few weeks (!!!!!!!!), hope that I’ll like my new graduate program, hope that I’ll be able to pay my bills, hope that I’ll get a job when this is all over, hope that my life will slowly start to resemble, however crudely, the vision I have had for it.

This means trying to see clearly through the fog that has hung like a curtain in front of my eyes since childhood, and occasionally getting a peak behind that curtain. We are all, of course, largely ignorant when it comes to predicting our own futures, but the important thing is to have the ability to make predictions that don’t make us want to curl up under the covers and cry.